Titre :

Clinical spectrum and short-term outcome of adult patients with purpura fulminans: a French multicenter retrospective cohort study.

Auteur(s) :

Contou, Damien [Auteur]
Centre Hospitalier Victor Dupouy
Sonneville, Romain [Auteur]
Hôpital Ambroise Paré [AP-HP]
Canoui-Poitrine, Florence [Auteur]
Colin, Gwenhael [Auteur]
Coudroy, Remi [Auteur]
Centre hospitalier universitaire de Poitiers = Poitiers University Hospital [CHU de Poitiers [La Milétrie]]
Pene, Frederic [Auteur]
Tadie, Jean-Marc [Auteur]
Centre d'Investigation Clinique [Rennes] [CIC]
Cour, Martin [Auteur]
Cardiovasculaire, métabolisme, diabétologie et nutrition [CarMeN]
Beduneau, Gaetan [Auteur]
Marchalot, Antoine [Auteur]
Guerin, Laurent [Auteur]
Jochmans, Sebastien [Auteur]
Ehrmann, Stephan [Auteur]
Centre Hospitalier Régional Universitaire de Tours [CHRU Tours]
Terzi, Nicolas [Auteur]

Preau, Sebastien [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Barbier, Francois [Auteur]
Schnell, Guillaume [Auteur]
Roux, Damien [Auteur]
Laboratoire d'Informatique, de Modélisation et d'Optimisation des Systèmes [LIMOS]
Leroy, Olivier [Auteur]
Pichereau, Claire [Auteur]
Gelisse, Elodie [Auteur]
Zafrani, Lara [Auteur]
Layese, Richard [Auteur]
Service de santé publique [Mondor]
Brun-Buisson, Christian [Auteur]
Hôpital Henri Mondor
Mekontso Dessap, Armand [Auteur]
De Prost, Nicolas [Auteur]

Titre de la revue :

Intensive Care Medicine

Nom court de la revue :

Intensive Care Med.

Numéro :

44

Pagination :

1502-1511

Éditeur :

Springer Verlag

Date de publication :

2018-08-20

ISSN :

0342-4642

Mot(s)-clé(s) :

Sepsis
Neisseria meningitidis
Streptococcus pneumoniae
Septic shock
Purpura fulminans
Limb amputation

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

Purpose Data on purpura fulminans (PF) in adult patients are scarce and mainly limited to meningococcal infections. Our aim has been to report the clinical features and outcomes of adult patients admitted in the intensive ...
Lire la suite >Purpose Data on purpura fulminans (PF) in adult patients are scarce and mainly limited to meningococcal infections. Our aim has been to report the clinical features and outcomes of adult patients admitted in the intensive care unit (ICU) for an infectious PF, as well as the predictive factors for limb amputation and mortality. Methods A 17-year national multicenter retrospective cohort study in 55 ICUs in France from 2000 to 2016, including adult patients admitted for an infectious PF defined by a sudden and extensive purpura, together with the need for vasopressor support. Primary outcome variables included hospital mortality and amputation during the follow-up period (time between ICU admission and amputation, death or end of follow-up). Results Among the 306 included patients, 126 (41.2%; 95% CI 35.6–46.9) died and 180 (58.8%; 95% CI 53.3–64.3) survived during the follow-up period [13 (3–24) days], including 51/180 patients (28.3%, 95% CI 21.9–35.5) who eventually required limb amputations, with a median number of 3 (1–4) limbs amputated. The two predominantly identified microorganisms were Neisseria meningitidis (63.7%) and Streptococcus pneumoniae (21.9%). By multivariable Cox model, SAPS II [hazard-ratio (HR) = 1.03 (1.02–1.04); p < 0.001], lower leucocytes [HR 0.83 (0.69–0.99); p = 0.034] and platelet counts [HR 0.77 (0.60–0.91); p = 0.007], and arterial blood lactate levels [HR 2.71 (1.68–4.38); p < 0.001] were independently associated with hospital death, while a neck stiffness [HR 0.51 (0.28–0.92); p = 0.026] was a protective factor. Infection with Streptococcus pneumoniae [sub-hazard ratio 1.89 (1.06–3.38); p = 0.032], together with arterial lactate levels and ICU admission temperature, was independently associated with amputation by a competing risks analysis. Conclusion Purpura fulminans carries a high mortality and morbidity. Pneumococcal PF leads to a higher risk of amputation.Lire moins >

Langue :

Anglais

Audience :

Internationale

Vulgarisation :

Non

Établissement(s) :

Inserm
Université de Lille
CHU Lille

Collections :

• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286

Équipe(s) de recherche :

Glycation from inflammation to aging

Date de dépôt :

2019-03-01T14:34:35Z
2023-05-03T08:54:01Z